NHS may be restricted to core services

The NHS is slowly moving in the direction of becoming a very costly organization that consists solely of bureaucrats and provides no services at all

The National Health Service might provide only core services, with patients forced to pay for any other treatment or meet it from private insurance, the government has revealed on Monday.

News that ministers were examining the possibility of defining the services that the NHS is obliged to provide free to everyone was disclosed in the small print of the public services policy review launched on Monday by Tony Blair, the prime minister, and Gordon Brown, the chancellor. It says the government should “look at the possibility of drawing up a package of services that all users are entitled to”. Nice, the National Institute for Health and Clinical Excellence, could be asked to do that.

The health department confirmed it was “looking at the possibility in the normal process of policy development” and agreed that deciding what everyone was entitled to would also involve deciding “what they are not entitled to”.

Academics said that amounted to defining a “basic basket” of services the NHS would fund, but warned it was fraught with technical and political difficulties. Anna Dixon, deputy director of policy at the King’s Fund think-tank, and a specialist on international health systems, said: “It sounds like establishing a core package of benefits that the NHS will fund – and that is something that has long been debated in academic circles. But politicians ... have always shied away from being more explicit about entitlements.”

Social insurance systems tended to be much more explicit about what was and was not covered, with private insurance markets developing to cover excluded treatments, she said. But she warned that when lists of exclusions were drawn up, “they often do not feel right to the public”. It was “a very difficult exercise” and one that, if undertaken, “is going to be very controversial”. It would raise issues over whether infertility treatment, or so-called lifestyle drugs for obesity or impotence, should be included.

David Hunter, professor of health policy at Durham University, said: “It is very difficult to define what is in the basket, so either it doesn’t get done or very little gets left out. You don’t save much, and you are still left with the issues of how to ration care and assess quality and cost effectiveness” – something Nice was already doing but “in a rather less prescriptive way”.

Patricia Hewitt, the health secretary, was deputy chairman of a pharmaceutical industry-financed study in 1995 that called for restrictions on free services. But she disowned the report on becoming health secretary, saying the government’s big increase in NHS spending removed the need for such measures.

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EXERCISE AND OBESITY: CHICKEN OR EGG?

Are people fat because they exercise less or do they exercise less because they are fat? The study below cannot not tell us. But why bother with proof when you KNOW what is going on? A pity that what people KNOW is often not true

The risk of children becoming obese could be halved with 15 extra minutes of moderately vigorous exercise each day, study results have suggested. All that is needed is a short game of football or a walk to school brisk enough to get slightly out of breath. The effects are greater in boys than in girls, but both sexes benefit. The findings point to a lack of exercise, rather than gluttony, as the key to obesity in young people. Researchers were surprised to find that boys have just 25 minutes of activity each day on average, and girls only 16 minutes.

The data comes from the Children of the 90s project, which has followed a group of children born in Avon in the 1990s. The Avon Longitudinal Study of Parents and Children is one of the biggest and most ambitious cohort studies ever attempted and is producing some of the best evidence on the effects of diet and lifestyle on disease. Researchers fitted 5,500 children aged 12 with activity meters to measure how much exercise they took. The children wore the meters around their waists, taking them off only to sleep, bath or swim. Their body fat was measured using an X-ray emission scanner, which can distinguish between fat and muscle. The results are published in PLoS Medicine.

Professor Chris Riddoch, of the London Sport Institute at Middlesex University, one of the project leaders, said: "We know that diet is important, but what this research tells us is that we mustn't forget about activity. It's been really surprising to us how even small amounts of exercise appear to have dramatic results."

The boys who took the most vigorous activity were more than 30 times less likely to be obese than those who took the least. An extra 15 minutes a day of moderate and vigorous physical activity halved the risk of obesity. Among girls the effects were less dramatic, but still significant. The most active fifth of girls reduced their risk of obesity by two thirds compared with the least active fifth.

Professor Andy Ness, of the University of Bristol, said that the most important activity was the kind that got the children slightly out of breath, or in a sweat. "Recommending an extra 15 minutes of vigorous activity a day may not sound very much, but it is actually double what the average 12-year-old girl does," he said. "In the context of what they are doing, it is quite a lot."

Why the effects should be so much greater in boys remains puzzling. "It could be physiological differences but I think that's unlikely," Professor Ness said. "The other possibility is that boys and girls use activity differently. Boys tend to use activity as the main weight control mechanism, while girls tend to control their weight by eating less." He said that surveys and food production statistics suggested that total calorie intakes had not increased. Yet obesity was rising, so it was reasonable to suggest that this was the result of burning less energy. "Lots of opportunities for activity are factored out of children's lives these days," he said. "There are more sedentary opportunities - sitting in the car, watching television, playing computer games. There's less walking to school, and when they get home Mum and Dad don't want them wandering off into the woods or playing in the streets."

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Red nose ban

Health and safety chiefs have banned guests at Comic Relief Does Fame Academy from wearing red noses. Producers planned to give the soft foam noses to contestants' friends and family during the live shows. But officials at London's historic County Hall feared the noses may be a fire risk, reports the Daily Mirror.

A show insider said: "It's a bit ridiculous to stop adults in the audience from wearing red noses. "It's a shame because the show is to raise money and it might have encouraged more people to go out and buy the noses if they saw them on telly."

A spokeswoman for show-makers Endemol said: "It is true red noses are not allowed - but neither are newspapers, bottles, bags and all manner of other items. "We are filming in a Grade II listed building and anything that is a potential fire risk or can cause damage when dropped is not allowed. We are working with essential equipment only."

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